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. 2026 May 21;22(3):e70200. doi: 10.1111/mcn.70200

Breastfeeding Experiences of Aboriginal Women With Child Protection Involvement: A Qualitative Study

Amanda L Peek 1,2,✉, Sharynne L Hamilton 1,3, Natasha Jojo 3, Marjorie Atchan 3, Karel Williams 3, Holly Northam 1,3
PMCID: PMC13205708  PMID: 42169401

Abstract

The rates of Aboriginal and/or Torres Strait Islander infant removal are disproportionately rising, affecting mother–infant attachment, disrupting breastfeeding and preventing infants' access to optimal nutrition. This significantly contributes to negative long‐term health and wellbeing outcomes of children. Operating at the intersection of midwifery care and child protection services presents an ethical dilemma for midwives, who are required to provide culturally safe and respectful care while working with women during the perinatal period. The aim of this article is to present the exploration of breastfeeding experiences of Aboriginal women, in the Australian Capital Territory, in the context of a child protection intervention or child removal. Using an Aboriginal Participatory Action Research approach, data were collected using a social and research‐topic yarning method, with five Aboriginal women. Data were analysed using reflexive thematic network analysis and then reanalysed through an interpretivist lens to present the data as vignettes. Women who had child protection involvement reported a lack of breastfeeding support from midwives and nurses that resulted in disrupted and unsupported breastfeeding. The women's involvement with child protection services led to experiences of stigma, oppressive practices and judgemental attitudes from midwives and nurses, that are evidence of professional breaches which impacted the mothers and infants' ability to benefit from breastfeeding. These findings point to the urgent need for midwives, nurses, and child protection workers to 1. Be accountable to work in culturally safe ways; 2. To privilege breastfeeding and 3. Provide supports to empower women to breastfeed to enable infants to have the ‘best start in life’ for an equitable future. Restorative approaches are proposed as a way forward to address these relational harms.

Keywords: Aboriginal women, breastfeeding, child protection, cultural safety, ethical dilemma, Midwifery, restorative approaches, stigma

Summary

  • Breastfeeding significantly influences the long‐term wellbeing of mothers and infants, and its uptake is poorly understood in the context of child protection interventions.

  • This study provides evidence of professional breaches by midwives and nurses which impacted the mother and infants' ability to benefit from breastfeeding.

  • Aboriginal women experience stigma, oppressive practices, judgemental attitudes and minimal breastfeeding support from midwives and nurses, when child protection is involved.

  • Midwives, nurses, and child protection workers urgently need to be accountable to work in culturally safe ways, to privilege breastfeeding and support and empower women to breastfeed to enable their infants an equitable future.

1. Introduction

Breastfeeding is vital to the wellbeing of the mother and child (Gribble and Gallagher 2014; Hernandez‐Cordero and Perez‐Escamilla 2022), is recognised as a human right to enable an infants' healthy future (COAG Health Council 2019) and is crucial for optimal growth and development (World Health Organization & UNICEF 2014). The World Health Organisation recognises breastfeeding as the best source of nourishment for infants, and is vital to achieving the highest standard of health (World Health Organization 2018). Breastfeeding provides essential, irreplaceable nutrition to optimise a child's growth and development, enhances maternal wellbeing, and privileges infant‐mother bonding. The removal of an infant, a child under 2 years of age (Arabena 2014), from their mother has profound implications, from the disruption of breastfeeding to inhibiting mother‐infant attachment (Weaver et al. 2018). The opportunity for an infant to bond with their mother is crucial to the short, medium, and long‐term health of the infant (Marsh et al. 2017). Secure and early mother‐infant attachment, which breastfeeding strongly encourages, is important for future interpersonal skills, and is protective; the longer the duration of breastfeeding the greater maternal sensitivity towards her child beyond the infant‐toddler period (Weaver et al. 2018).

Globally (Chiang et al. 2021; Health Canada 2012; Manhire et al. 2018; Mitchell et al. 2023), the impacts of colonisation, and the forced separation of mothers and children has resulted in 6%–10% lower breastfeeding initiation rates of Indigenous mothers than non‐Indigenous mothers. Similarly in Australia, the impact of colonisation and genocidal legacies including the continuing intergenerational impact of the Stolen Generations have severed or disrupted the relationships and well‐being of Aboriginal and/or Torres Strait Islander mothers and their infants (Mitchell et al. 2023).

Ongoing social change including the introduction and marketing of commercial milk formula as a healthy alternative to breastfeeding (Hull et al. 2025; Mitchell et al. 2023) and societal judgement are known to create additional barriers to breastfeeding when breastfeeding in public meets with disapproval (Grant et al. 2022).

Traditional ways of looking after children were communal, and breastfeeding up to 4‐years of age was a normal part of life for Aboriginal and/or Torres Strait Islander mothers prior to colonisation (Mitchell et al. 2023). Though this practice is still traditional in some locations, the forced removal of children from their kin, families and communities (Human Rights and Equal Opportunity Commission 1997), accounts for the destruction of cultural practices in many places, including the cultural knowledge of breastfeeding (Springall et al. 2024). Removal of an infant from their mother, is a contributing factor to the lower breastfeeding rates of Aboriginal and/or Torres Strait Islander women (Springall et al. 2024). Unsurprisingly, a distrust in Western health systems and a lack of culturally safe breastfeeding support services can influence the breastfeeding decisions of Aboriginal and/or Torres Strait Islander mothers (Mitchell et al. 2023). Associated with these challenges is the reality that Aboriginal and/or Torres Strait Islander infants experience much higher rates of morbidity and mortality than non‐Indigenous infants (Australian Institute of Health and Welfare 2024). Child mortality rates are twice that of non‐Indigenous children and life expectancy for Aboriginal and/or Torres Strait Islander peoples is 8‐years less than non‐Indigenous Australians (Australian Institute of Health and Welfare 2024).

Contemporary Australian rates of exclusive breastfeeding in the first month are comparable between Aboriginal and/or Torres Strait Islander and non‐Indigenous mothers (Australian Bureau of Statistics 2019). Sadly, as infant age increases the rate of exclusive breastfeeding declines more rapidly for Aboriginal and/or Torres Strait Islander infants, an 86.8% Indigenous vs 90% non‐Indigenous initiation rate reducing to 11% Indigenous vs 27.2% non‐Indigenous rates of exclusive breastfeeding at less than 5 months of age (Australian Bureau of Statistics 2019; Australian Institute of Health and Welfare 2010). Of non‐Indigenous infants, 91% under 3‐years of age have ever breastfed (Australian Bureau of Statistics 2022), compared to 83% of Aboriginal and/or Torres Strait Islander infants of the same age (Australian Bureau of Statistics 2022–23).

Aboriginal and/or Torres Strait Islander children are 11 times more likely to be removed from their family and placed in OOHC than their non‐Indigenous peers (Australian Institute of Health and Welfare 2025). Newborn infants represent the most vulnerable group admitted into OOHC (Marsh et al. 2017). Infant removal is developmentally disruptive, negatively impacting both the establishment and continuance of breastfeeding and its associated benefits, and negatively impacting mother‐infant attachment (Gribble and Gallagher 2014). Significantly, in the Australian Capital Territory (ACT), where this research was undertaken, Aboriginal and/or Torres Strait Islander infants under 1‐year of age are 24.5 times more likely than non‐Indigenous infants to be removed from their parents (Australian Institute of Health and Welfare 2025). We propose that by gaining a better understanding of the experiences of Aboriginal and/or Torres Strait Islander women who have experienced a child protection intervention or child removal in the ACT, there is an opportunity to structure better support for the women, their infants and their families to enable breastfeeding to be supported and maintained. It is possible increasing breastfeeding rates for Aboriginal and/or Torres Strait Islander women has the potential to contribute to closing the inequitable health gap experienced between non‐Indigenous and Indigenous Australians (Mitchell et al. 2023; Zheng et al. 2022). Therefore, the aim of this article is to present the exploration of breastfeeding experiences of Aboriginal women, in the Australian Capital Territory, in the context of a child protection intervention or child removal.

2. Methods

An Aboriginal Participatory Action Research (APAR) approach underpins this research (Dudgeon et al. 2020). The APAR approach transfers power and uses a cyclical and reflective process that is iterative in nature. The use of this approach facilitates community‐driven solutions and Aboriginal community ownership over research outcomes (Dudgeon et al. 2020). With the community at the centre of the research, opportunities for consultation on the design, implementation, conduct, and translation of the research are realised (Dudgeon et al. 2020). Relationships and forums that support respectful knowledge sharing are supported using an APAR approach. An APAR framework has been utilised from the commencement of this research (Peek et al. 2024).

An Aboriginal Cultural Reference Group (ACRG), Aboriginal supervisor (SH; Ngunnawal) and Aboriginal colleague (KW; Palawa) have guided this research. Aboriginal Elders, community leaders, government representatives, and community organisations are represented in the ACRG that provides cultural knowledge and guidance to all aspects of this research, including but not limited to recruitment method, data collection method, theme development for yarns, and checking the credibility/authenticity of data interpretation. The cultural advisors facilitate trusting respectful relationships between the non‐indigenous authors (AP, HN, MA, NJ) and the Aboriginal community. Establishing trusting relationships enables knowledge to be shared, culturally secure research translation, and sustainable Aboriginal community‐identified research outcomes (Morey et al. 2023).

2.1. Participants

Given the sensitivity of this research and the small population size, it was recognised that it would be difficult to recruit to the study. Between July 2024 and December 2024, we were pleased to have five Aboriginal women in the ACT who had experienced a child protection intervention whilst breastfeeding, agree to participate in individual yarns with the first author. None of the five participants were Torres Strait Islander women. Purposive sampling was used to recruit participants, and a flier was developed for distribution to Aboriginal Community Controlled Organisations. Participants were also recruited through the support of Aboriginal community leaders and professional networks, by way of introduction, which assisted with recruitment. The size of the sample was considered to hold sufficient “information power” (Malterud et al. 2016, p. 1754), for lower participant numbers. From the collective data, a narrative becomes apparent that transcends the story of the individual and represents the story of the wider community (Reid et al. 2024). Diversity of experience was ensured by recruiting women who came from differing social and economic backgrounds and different Aboriginal nations; these characteristics were reflected by those who participated. The participants' children were now aged from 5 months to 28 years, with single parent, de facto, and married women represented. No participants declined or withdrew from the research. Yarns were conducted in person at a location chosen by the participant. All participants were thanked and received an AUD$50 gift voucher to acknowledge their contribution.

2.2. Data Collection and Analysis

Yarning has become an established research method, both in Australian and in global Indigenous studies (Bessarab and Ng'andu 2010). Yarning is a flexible process of knowledge sharing and respectful communication that allows for adaptations that may be required to support language or literacy differences (Hamilton et al. 2020). Yarns ranged in time, from 30 min to 3 h. Data were collected using a semi‐structured social and research topic yarning approach. Social yarning was used initially to establish a rapport between participant and researcher, followed by research‐topic yarning where information related to the research topic was gathered through participants' stories (Bessarab and Ng'andu 2010). Yarning disrupts the power held within the roles of researcher and participant and requires the interaction to be on a more equal footing, person to person (Bessarab and Ng'andu 2010).

Broad themes for discussion in the yarns were established in collaboration with the ACRG. The discussion themes aimed to draw out parts of the women's stories that focussed on breastfeeding support in hospital and in the postnatal period, particularly from midwives and maternity and child health (MACH) nurses who provide care to mothers after the hospital ceases to provide care at home. Themes included breastfeeding experience, support and services, and experience and views of child protection. All data was voice recorded or documented after the interview, transcribed and de‐identified during transcription, with transcripts kept on password‐protected computer files only accessible to the researcher.

Data were analysed using reflexive thematic network analysis, which encourages the authors to deliberately acknowledge their personal and theoretical perspectives, while being reflexive throughout the analysis of the data (Braun and Clarke 2023). Preliminary analysis was conducted by three authors (AP, HN, SH) immediately following data collection. (AP, HN, SH) followed an iterative process, individually reading the transcripts multiple times, highlighting important elements and themes, identifying subtle insights and nuances in the participants' stories to produce line‐by‐line codes that were recorded on a spreadsheet. Codes were then grouped into broad themes and checked for accuracy against the meaning generated within the transcripts. The authors discussed and checked the development of the themes and coding for consistency. Research team members, including the ACRG reviewed data themes. These reviews helped to ensure consistency in data interpretation through multiple perspectives and iterations. The lead researcher and team members conducted multiple data reviews at regular time points over 6 months to confirm and develop final data interpretations. Prior to submission for publication, vignettes and themes were shared with the relevant participant to ensure their story was being represented in a way that they found suitable.

To present the findings, vignettes were chosen to complement the yarning approach taken to data collection. Constructing vignettes offered a comprehensive way to provide a rich account of the participants' stories. It also provided a culturally relevant and safe method (Blodgett et al. 2011), for respectfully presenting the unique stories of the participants in this research. In preparing the vignettes, the data from all participants were re‐analysed through an interpretivist lens which acknowledges participant realities are socially constructed and changeable, and agreed within cultures, social settings, and relationships (Denzin and Lincoln 2003). From this process, two participants' experiences are shared in this paper based on the depth of available data, and data that represented the intersection between breastfeeding, maternal health services, and child protection involvement. The other three participants shared experiences that were consistent with the experiences and themes represented in the vignettes. Their stories will be elaborated on in a separate publication. All names are pseudonyms. Small details, such as immaterial but potentially identifying information, and references to specific personnel and institutions and demographics have been changed to protect participants' identities.

2.3. Ethics

This research has ethical approval from (#12010, University of Canberra). Participants were provided with an information statement and consent form and given the opportunity to ask questions about the research prior to providing written consent. All study participants provided fully informed written consent. Participants were informed that they could withdraw from the research at any point without negative consequences and were given an assurance of confidentiality in all publicly available information and peer‐reviewed publications. The rights of Aboriginal peoples to have control over their cultural intellectual property, communities, resources and Country in all aspects of this research were honoured (Maiam nayri Wingara Indigenous Data Sovereignty Collective & Australian Indigenous Governance Institute 2018).

3. Findings

The study identified five themes describing breast feeding experiences of Aboriginal women which included: Disruption of breastfeeding; Coercive and intimidatory practices creating fear; Lack of culturally safe midwifery support; Stigma and surveillance; and Intergenerational impacts of child removal. It was decided that vignettes offered a culturally safe (Blodgett et al. 2011) and comprehensive way to detail the participants' stories. Two vignettes were selected that revealed the experience of how the women were challenged in their efforts to breastfeed.

3.1. Vignettes

3.1.1. Carla and Archie

Carla is an Aboriginal woman, who had child protection involvement with several children over a period of 20 years. Her initial involvement with child protection services was when she was living with her partner and experienced significant levels of domestic and family violence. Over time, she and her children resided in supported accommodation and public housing and experienced a period of homelessness. Carla's children were all at different ages when child protection removed them. Carla described her experience when Archie, her fifth child was a newborn and breastfeeding was interrupted by midwives to prioritise a child protection meeting only a few hours after giving birth to Archie: “a midwife came into my room and said, ‘you need to stop [breastfeeding]…care and protection's here to see you’”. Carla asked: “why are they here, and what do they want, to which the midwife responded, ‘we've told them that everything seems to be fine between you and baby, we have no idea’.” Carla explained that she agreed to let them come into the room, however: “the midwife said ‘no, no, you've got to go to another room and have a meeting with them’.” Carla explained that Archie was still attached to her breast when she went to get off the bed: “the midwife said: Oh, no you need to stop feeding your baby. Your baby is not going with you, and you need to hand your baby over to your mother.” Carla was fearful that leaving Archie, she would not see him again: “so, I'm thinking… when I come back, my baby's gone. My baby's gone. I'm losing my baby.”

Prior to Archie's birth, Carla had no indication that child protection services were likely to come to the hospital when Archie was born. She had left the partner who was violent and had been working with various agencies to get support and had obtained stable housing. Early in her pregnancy, as a protective action, she had engaged with child protection advocates to ensure that child protection services knew she had support and that Archie would be safe to remain with Carla. When the midwife told Carla she needed to meet with child protection personnel she was very distressed. There was no offer from the hospital for social work support or a midwife to attend the meeting with Carla. Carla described this experience as threatening and oppressive: “I walk into the room and it's two men. Tiny, weeny little room, two men. Never met them. Sitting there asking me a whole heap of questions.” Carla went on, “so they turned around and said you need to stay in the hospital until we tell you, you can leave … If you leave this hospital with the baby, we will remove the baby. I remember the word was ‘allowed’ to come out of hospital. Like I was in some full sort of jail.”

Carla remained in the hospital with Archie for an extended period. She described one experience where she had positive support from midwives, saying “Amazing breastfeeding experience with the midwives, so supportive…They said,” “You're doing all the right things.” Overall, though, she described experiences of scrutiny and surveillance that extended well beyond the hospital intervention, that Carla described as “so very intrusive.” Carla was finally allowed to take Archie home. Despite child protection concerns, somewhat ironically, Carla was under surveillance that was free from scrutiny during the day but had overnight supervision. “I had to have [service name], come into my house. Every night from 5:00 to 9.00 am. I had to be watched while I was breastfeeding. I had to be watched while I bathed my child.” Carla also described feeling stigmatised in her service interactions: “dealing with the stigma with midwives, like constantly looking at you, and then the crap that you go through with the MACH [maternal and child health] nurses because you have care and protection involvement and the judgement that that comes with that. They're supposed to be supporting me, supporting my journey.”

Carla complied with all the requirements that child protection services expected, however Archie was eventually removed from Carla's care into foster care due to her mental health concerns. Carla was “allowed” to continue breastfeeding; however, the routine was decided by child protection services, she said: “I was allowed to continue breastfeeding Archie, but not at his times. So, I was allowed to go over to [Foster Carers] house every night to breastfeed Archie. The days I had contact it was deemed [by child protection] that I had [emphasis added] to breastfeed my son…I mean you try feeding a child at 11:00 in the morning when he's used to having a breastfeed at night.” Moreover, during these times Carla was often supervised by a male worker while breastfeeding Archie: “It was really uncomfortable having a male worker while I'm breastfeeding because it's not natural like they very obviously look away or try to not make eye contact … or they sit there and just very intently staring at your eyes.” Ultimately, breastfeeding or the provision of breastmilk was not encouraged when Archie was removed from Carla's care: “I tried to breastfeed him when I had contact. It wasn't overly supported. I wasn't offered to express and be able to give Archie expressed breastmilk for as long as I possibly could. He was just automatically put on formula.”

This vignette represents themes that were consistent with the experiences of the other women. Carla's vignette illustrates the lack of culturally safe midwifery support she received after the birth of Archie, while still in hospital. The disruption to her breastfeeding and separation from her baby inflamed her fear of removal. Carla experienced intimidatory and coercive practices by child protection, with inappropriate use of male practitioners in confined spaces with a vulnerable recently birthed breastfeeding mother. The fact that the midwife failed to advocate for Carla in this scenario is telling. The vignette exposes the stigma and over surveillance Carla experienced from midwives, maternal and child health nurses and child protection. Coercive control was used to restrict Carla's breastfeeding access to Archie without professional input.

3.1.2. Caitlin and Jane

Caitlin is an Aboriginal mother and grandmother, who had child protection involvement with all five of her children. Child protection involvement continues with her youngest child and oldest grandchild. Over the years, Caitlin resided in both supported accommodation and government housing. Caitlin felt guilt and regret that she struggled to provide the home environment her children required, though she realised this situation was through no fault of her own. Caitlin described her own memory of having her son removed while breastfeeding as “patchy,” explaining that this was due to the “effect of the stress of domestic violence.” She did not recall breastfeeding being encouraged after her child's removal from her care.

Her daughter, Jane, also experienced involvement with child protection services during pregnancy. Caitlin felt her daughter came under the scrutiny of child protection services because of her own time spent in the foster care system. Cailtin shared her daughter's story: “…Just because of me being in the system and everything, when they found out that she was pregnant, they only intervened, originally, because of that reason.”

On her release from the Neonatal Intensive Care Unit (NICU) with her newborn baby, Jane was provided with syringes and plungers for feeding her baby hand expressed breastmilk, and to give the baby vitamins. In telling her story, Caitlin recalled her own journey with a premature baby and having little knowledge about expressing breastmilk into syringes, “When they first passed me the plunger, I'm like what? I'm not sticking anything in my nipple. They're like ‘no’ and explained it.”

While at home with her newborn, Jane became ill and was hospitalised. Caitlin, with her own 6‐month‐old baby, was left to care for her newborn grandchild, while Jane recovered in hospital. Caitlin cared for both babies overnight, feeding them formula via bottles, despite being nervous: “that first night with [grandchild], I've got my own newborn baby, and [grandchild], usually I'd totally agree that it'd be too much…I'm just gonna have to do it.”

Child protection services became involved with Jane. The presence of syringes and the untidy state of her home were used against Jane as evidence of neglect. “They believed because it [the apartment], hadn't been attended to and cleaned up, that that was what he [grandchild] was gonna be taken home to…they said there were syringes everywhere. They weren't syringes. They were plungers given by the hospital.” Caitlin perceived breastfeeding or feeding expressed breastmilk as very important to Jane's premature baby and for mother‐baby bonding, “He needed that so much…that would have been beneficial to Jane.” Caitlin explained that Jane was just trying to be “the mum that she's required to be,” expressing breastmilk and giving medication as prescribed, but was misjudged on this.

Jane was angered by the accusations and began to argue with care and protection workers, but Caitlin encouraged her to comply with the demands of child protection. “It was one of the hardest things I've ever had to do is to sit there and encourage my daughter, that's the only way I could see it being less traumatising as possible to say “I know [daughters nickname].” But just if you go off, it's the worst thing for you. It's the worst thing for the situation.” Child protection wanted to undertake a medical check on Jane's baby to “make sure he is ok,” but when Caitlin asked to accompany them, she was denied. Jane's baby was removed from her care and placed with Jane's Nan, which with the additional distress of her illness, compounded her trauma and eventually led to poor mental health. Caitlin shared her feelings about her daughter's journey: “It was a long road for her. She had all that trauma and was treated like that … she wasn't in her right mind.”

Caitlin believed Jane was put in an environment that negatively impacted the production of her breastmilk, and this added to Jane's feelings of “worthlessness” as a mother, “…it would have added to her feelings of hopelessness, worthlessness, and that as a mother.” “Ultimately, Jane did not seek the return of her child to her care. Caitlin described Jane's reason for this, saying ‘Mum, he's been with Nan for so long. That it'd be like what they did to me to do that’.”

Caitlin's vignette demonstrates the traumatic intergenerational effect of child removal as she shares her daughter Jane's story and how it resonates with her own. Centred around her daughter's experience of child removal after being hospitalised, the stigma that often associates Aboriginal women as substance abusers by child protection workers, nurses and midwives (Queensland Mental Health Commision 2020), is dominant. Culturally unsafe practices are evident when mother and baby are separated, and the grandmother was denied the right to stay with the baby which contributed to further trauma. This vignette emphasises Caitlin's need to silence her daughter Jane in fear that if Jane showed her anger and frustration at her treatment it would lead to the removal of her baby. Caitlin's experience highlights the institutional power differential favouring medical and child protection authorities as a form of coercive control. Themes within this vignette reflected those experienced by the other women.

4. Discussion

The vignettes highlight how the themes of stigma, surveillance, coercive and intimidatory child protection practices, culturally unsafe midwifery support, disrupted breastfeeding, and the intergenerational impacts of child removal played out at the intersection of child protection involvement and Aboriginal mothers receiving support for breastfeeding their infants. These themes show how child protection practice fails to provide culturally safe support to families, and is dominated by racialised governance shaped by colonial reasoning (Davis 2019). When power, racism, and colonial legacies intersect at the interface of maternity care and child protection, it is Aboriginal and/or Torres Strait Islander children who are harmed through removal from their family, culture, and Country (Duthie et al. 2019; Lonne et al. 2020). With the introduction of pre‐birth alerts and the resulting involvement of child protection postnatally, the role of the midwife shifts from providing support to surveillance of the mother (Harrison et al. 2015).

Breastfeeding support is a key component of midwifery care, yet disruption to breastfeeding regularly occurs when there is child protection involvement (Gribble and Gallagher 2014). A study of foster carer's views of breastfeeding (Blythe et al. 2022) shows that breastfeeding becomes a site of control, and it is foster carers, child protection workers and midwives who hold the decision‐making power. Moreover, Aboriginal and/or Torres Strait Islander women with child protection interventions are stigmatised and experience oppression and high levels of surveillance during both pre‐ and post‐natal care (Hine et al. 2023). Child protection authorities hold statutory power, and the work of midwives is embedded in relations of medical power and authority (Jutel and Nettleton 2011). Midwives are trusted by women to support them through pregnancy, the birth of their babies and the early weeks of their life, including with breastfeeding (Baron et al. 2017). Yet, for the women in this study, it was evident that breastfeeding support by midwives was not always provided. A systematic review by Baker et al. (2023) identified that insufficient breastfeeding support existed for women with mental illness because of midwives' lack of knowledge and confidence in supporting these women. For example, Carla, who reported poor mental health, was told by a midwife to stop breastfeeding, hand over her newborn to her mother, and attend a meeting alone with two male child protection workers. The feelings of fear and experience of powerlessness and oppression meant Carla was voiceless and had her agency and autonomy taken from her, as found in other scholarly work (Aston et al. 2021). Carla had no offer of support from the midwife, nor was there any attempt to ensure she had social work support from the hospital, even though she had only hours earlier given birth to her baby. Carla's experience reflects the work of Aston et al. (2021), who found that women experienced a lack of support by healthcare workers and had to search for their own support to be able to engage safely with child protection services. Similarly, Caitlin followed the directions of the NICU midwives, believing that by doing so, she would meet the standards that constitute a “good’ mother” (Sonnenburg and Miller 2021), and “be the mum that she's required to be.” There was no evidence that the midwives or nurses advocated for Jane when questions were asked of her about the use of syringes, even though this is standard practice for expressing breastmilk (Whitburn 2022). Further, both women felt stigmatised by midwives because of their child protection involvement and spoke about unfair judgements and decision‐making (McDonald et al. 2025; Newton et al. 2024). Irrespective of their experiences, the importance of breastfeeding was not lost on the participants. In failing to support and promote breastfeeding, midwives denied infants the right to optimal nutrition and the associated health benefits (Victora et al. 2016; World Health Organization & UNICEF 2014). Caitlin emphasised the importance of breastfeeding for her premature grandchild and talked about how this was ignored by child protection services (Theurich et al. 2021). She also felt the environment her daughter was placed in was not supportive of breastfeeding, discussing how this situation added stress and affected her daughter's ability to breastfeed her baby (Gribble and Gallagher 2014).

The vignettes highlight the intergenerational nature of child protection involvement and the levels of scrutiny and surveillance that women involved with child protection can be subject to (Newton et al. 2024). Notably, Carla spoke about how surveillance was often disguised as “support,” which has been shown elsewhere to be a subversive practice (Hine et al. 2023). In the vignettes, midwives were implicated in these discussions, yet surveillance on behalf of the child protection agency is not the role of midwives (Peek et al. manuscript under review 2025). Midwives have ethical obligations to provide woman‐centred, respectful and compassionate care, free of bias (Nursing and Midwifery Board of Australia 2022). In both vignettes, midwives and nurses clearly did not advocate for the breastfeeding rights of the women, nor did they demonstrate meaningful recognition of the rights of their infants to breastmilk and potential benefits to their long‐term health and wellbeing (Grummer‐Strawn et al. 2017). There were some instances of respectful and compassionate support, Caitlin being supported to increase her knowledge of expressing breastmilk, and Carla feeling supported by a midwife who was encouraging. It was notable that breastfeeding was largely not supported while the women were in hospital or once they were discharged, which is in contrast with the Midwife standards for practice (Nursing and Midwifery Board of Australia 2018).

The findings highlight that ethical dilemmas have arisen from conflicts at the interface of midwifery care and child protection practice and show the influence divergent priorities can have on breastfeeding Aboriginal and/or Torres Strait Islander women and their babies. Given the existing lower rates of breastfeeding among Aboriginal and/or Torres Strait Islander women (Australian Bureau of Statistics 2019), and the well‐established long‐term health benefits that breastfeeding produces (Victora et al. 2016; World Health Organization & UNICEF 2014), it is important that all health professionals prioritise supporting breastfeeding. Given the prominence of the role of the midwife, maternal child health nurses, and other health and social care professionals, there is a need to hold professionals accountable for their practice and callout breaches in standards and ethical care. It is necessary to develop and disseminate guidelines that highlight the rights of the child and prioritise breastfeeding and culturally safe support when women are involved with child protection services. Clear policies and guidelines that define how to respond to requests from child protection services who are involved with women in the pre‐ and post‐birthing period will support midwives' and nurses' capacity to meet their professional and ethical obligations. Furthermore, midwives and nurses would benefit from trauma‐informed education when providing care to Aboriginal and/or Torres Strait Islander women. As highlighted by Williams et al. (2026), who promote culturally inclusive models of care, “Birthing with Country is essential to disrupt fear and surveillance, build trust, and support wellbeing” (Williams et al. 2026, p. 1).

Further research is needed to explore midwifery care where women have child protection involvement and the long‐term impact on their children when breastfeeding is negatively impacted. This need is particularly relevant in hospitals where the removal of infants from their mothers is rising, with a resulting negative influence on breastfeeding rates in a vulnerable group (Australian Institute of Health and Welfare 2024). Potential exists for reorienting the care of women and infants where child protection is involved to a system that supports breastfeeding and reduces stigma and fear by embracing more collaborative and restorative approaches to care. For Aboriginal and/or Torres Strait Islander women, there is a need to embrace communitarian ways of looking after children and explore midwifery models of care that is inclusive of family. The non‐Indigenous authors of this paper, in collaboration with the Aboriginal authors, are committed to and understand they are responsible and accountable to callout the social harms experienced by Aboriginal women in maternity care and amplify the women's voices.

4.1. Limitations

It is acknowledged that a limitation of this study is the small participant numbers. Another potential limitation is selection bias due to purposive sampling and recruitment supported by Community Leaders because it relies on the subjective judgement of the leaders of people known to them rather than a random cohort. The voluntary nature of recruitment may also only attract participants who had bad experiences an outcome of self‐selection bias (Hiratsuka 2025). This paper reports on two of the five participants, though the findings were representative of the remaining participants. The decision to present the experiences of two participants as vignettes was to protect the women's identities and to enable an accurate representation of their experiences. Importantly, the risk of the non‐Indigenous authors not understanding or misinterpreting the experiences of the participants was high; however, this risk was addressed by the guidance and critique of two Aboriginal authors and a Cultural Reference Group.

5. Conclusion

Despite the known nutritional benefits of breastfeeding to the long‐term health and wellbeing of infants, the findings from this study demonstrate the conflict which can arise in maternal care, when women have child protection involvement. In the experience of these Aboriginal women, the effects are profound and continuing. For all Aboriginal and/or Torres Strait Islander women, the history of colonisation and impact of forced removals, has resulted in intergenerational trauma and fear across families and generations, with experiences of disproportionately high rates of infant removal and consequent loss of breast‐feeding opportunities. These findings point to the urgent need for midwives, nurses, and child protection workers to be accountable to work in culturally safe ways including practices that privilege breastfeeding, wrap around supports to empower women to breastfeed, and governance to enable infants to have the “best start in life” for an equitable future. To stem potential further harm, midwives and nurses need to realise the responsibility to and care for Aboriginal and/or Torres Strait Islander women and children involved with child protection services, in a way that enables them to prioritise the rights of their infants to breastmilk.

Author Contributions

A.P., H.N., S.H., M.A., and N.J. contributed to the design and implementation of the research. A.P. and K.W. were involved in participant recruitment, A.P., S.H., and H.N., conducted the analysis of the results. A.P. and S.H. wrote the initial drafts of the manuscript. All authors critically reviewed the manuscript, and S.H. and K.W. ensured that the research processes and manuscript maintained cultural integrity.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

We acknowledge the Ngunnawal Elders, their ancestors and peoples, who have inspired, guided and supported this work. We acknowledge and thank the Cultural Reference Group including [Aunty Roslyn Brown], [Barbara Causon PSM], and [Jessemyn Luckhurst], who provided guidance to this study. We acknowledge and support all Indigenous peoples continuing their fights for justice. No content generated by AI technologies has been used in this study. This research was supported by an Australian Government Research Training Program (RTP) Scholarship https://doi.org/10.82133/C42F-K220. This work was supported by the University of Canberra Collaborative Indigenous Research Initiative. Open access publishing facilitated by Western Sydney University, as part of the Wiley ‐ Western Sydney University agreement via the Council of Australasian University Librarians.

Data Availability Statement

Due to the sensitive nature of the questions asked in this study, participants were assured raw data would remain confidential and would not be shared.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Due to the sensitive nature of the questions asked in this study, participants were assured raw data would remain confidential and would not be shared.

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